Double patch closure of ventricular septal defect with increased pulmonary vascular resistance
| Autor: | Ivan Malčić, Alexander N Perepeka, William M. Novick, A.Tayfun Gurbuz, Donald C. Watson, Thomas G. DiSessa, Vasily V Lazorishinets, Bruce S. Alpert, Branko Marinović |
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| Rok vydání: | 1999 |
| Předmět: |
Pulmonary and Respiratory Medicine
Inotrope Heart Septal Defects Ventricular congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Heart disease Adolescent Hypertension Pulmonary Pulmonary Artery law.invention law Hypothermia Induced Internal medicine medicine.artery Cardiopulmonary bypass Methods Medicine Humans Child Postoperative Care Heart septal defect Cardiopulmonary Bypass business.industry Respiratory disease Infant medicine.disease Pulmonary hypertension Surgery medicine.anatomical_structure Child Preschool Pulmonary artery Vascular resistance Cardiology Vascular Resistance Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of thoracic surgery. 66(5) |
| ISSN: | 0003-4975 |
| Popis: | Background. Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance is associated with significant morbidity and mortality. Pulmonary hypertensive episodes continue to be a major cause of postoperative morbidity and mortality. We designed a fenestrated flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonary vascular resistance. Methods. Eighteen children (mean age, 5.7 years) with a large VSD and elevated pulmonary vascular resistance (mean, 11.4 Wood units) underwent double patch VSD closure using moderately hypothermic cardiopulmonary bypass and cardioplegic arrest. The routine VSD patch was fenestrated (4 to 6 mm) and on the left ventricular side of the patch, a second, smaller patch was attached to the fenestration along its superior margin before closure of the VSD. Results. All children survived operation and were weaned from inotropic and ventilator support within 48 hours postoperatively. Postoperative pulmonary artery pressures were significantly lower than preoperative values. One child died 9 months postoperatively. Conclusions. Closure of a large VSD in children with elevated pulmonary vascular resistance can be performed with low morbidity and mortality when a flap valve double VSD patch is used. |
| Databáze: | OpenAIRE |
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